The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery: The SYNTAX Study One Year Results of the PCI and CABG Registries.

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Presentation on theme: "The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery: The SYNTAX Study One Year Results of the PCI and CABG Registries."— Presentation transcript:

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The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery: The SYNTAX Study One Year Results of the PCI and CABG Registries Friedrich W. Mohr MD PhD Patrick W. Serruys MD PhD On behalf of the SYNTAX investigators Conflicts of Interest: None

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Background l In the past five years several studies that have compared contemporary treatment of CAD by CABG and PCI (e.g. New York Registry) have been reported. These trials showed a risk-adjusted decrease in 5-year mortality in favor of CABG when the proximal LAD was involved. Hannan et al, New Engl J Med 2008;335:331-341

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Registries Objective Patients were identified who were not candidates for randomization based on clinical or anatomical characteristics and formed the basis for the registry experience: Who were not candidates for CABG (inoperable patients) Who were not candidates for PCI (technically not feasible)

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Registries Methodology Treatment schedule and follow up visits identical with RCT Major adverse cardiac and cerebrovascular events 100% monitored 20% of patient data at each site (every fifth patient) was fully monitored No statistical comparisons between randomized and registry were performed

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Conclusions Registries Patients (N=1275) were identified as unsuitable candidates for randomization based on clinical or anatomical characteristics, and formed the basis for the registry experience Patients (N=198) who were not candidates for CABG form a small population to study the outcomes of inoperable patients Patients (N=1077) who were not candidates for PCI form an ideal population to study the results of current surgical practice

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The CABG registry patients who are technically unsuitable for PCI have the most complex lesion anatomy as expressed by a higher SYNTAX score In the CABG registry the 12 month outcomes are: All Cause Death 2.5% CVA 2.2% MI 2.5% Repeat Revascularization 3.0% MACCE 8.8% Conclusions CABG Registry

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General Conclusions SYNTAX Trial The SYNTAX trial has enrolled a large number of patients with LM and/or 3 VD to evaluate optimal strategies of care. In these patients we can conclude: The Primary Endpoint (12 months MACCE) in this non- inferiority trial for PCI was not met. PCI continues to improve as do surgical techniques In this trial the Heart Team concluded that CABG remains the only treatment option for at least 1/3 of the patients screened In patients who are not candidates for PCI, surgical results are excellent In patients who are not candidates for CABG, PCI is a viable option